Brittle health system hinders GPs and patients

19 July 2012

Surely we can do better than that in Australia, says Dr Renee Otmar.

What kind of health system restricts medical practitioners from doing their job properly?

That’s the question Deakin University researcher Dr Ren?e Otmar found herself asking after conducting a study that looked at general practitioners’ attitudes and beliefs about osteoporosis and its investigation and management.

The study was part of a broader exploration of knowledge, beliefs, attitudes and cultural models of osteoporosis, conducted over a three-year period. Dr Otmar gathered data for the qualitative study through interviews and focus groups held with fracture patients at Geelong Hospital and members of the general community, GPs and orthopaedic surgeons across the Geelong region.

Geelong GPs were invited to participate in the study through focus groups, and 14 GPs and two associated practice nurses volunteered. Four focus groups were held, with 3–5 participants. The GPs were aged 27–89 years and most were males working in shared medical practices.

“What we found was a real ambivalence about osteoporosis among the GPs, in particular,” Dr Otmar said.

“The GPs agreed that osteoporosis was potentially a debilitating condition, but few said that they would initiate an investigation for osteoporosis as a preventative measure.”

This reluctance was due to perceived financial barriers, rather than a lack of care. The GPs were concerned that many of their patients would not be able to afford to pay for non-critical tests and osteoporosis medications if they should need it.

Bone-density scans are subsidised by Medicare for evaluation of low-trauma fracture, monitoring in individuals with low bone density, fracture risk assessment in those aged 70 years and older and evaluation of individuals with diseases or exposures know to reduce bone density or predispose to fracture. The out-of-pocket cost to patients who do not meet these criteria is about $100.

Osteoporosis medication is subsidised under the Pharmaceutical Benefits Scheme to prevent fracture in people aged 70 years and older considered at risk of fracture.

Dr Otmar expressed concern that GPs are unable to take a preventive approach because they are worried about costs.

“GPs have to do so many things when they consult with their patients, including assessing whether they can afford to pay for non-urgent tests and medication if they should need it,” she said.

“It is wrong that the detection and treatment of something as potentially debilitating as osteoporosis is not being done because the doctor knows the patient cannot afford it.”